Joe,
You may be right in saying that swearing about excreta opens the doors to discussion. But using swearwords day in and day out does not in my view constitute or promote sincerity. It is more of an evasive and euphemistic approach clearly revealing a person's inability to deal with this question in an equitable and honest fashion. It sounds tougher to swear when one is dealing with sensitive taboo questions. It gives one an escape route to avoid being labeled as a social deviant. I think the taboo forces people towards shaming and swearing about it. So dealing with the taboo in a constructive fashion is an important step.

CLTS on the one hand is heavily loaded with shame and embarrassment as central drivers to catch people's attention. And many of the CLTS people prefer to use swear words to describe what they do. But CLTS does actually take on the taboo in its special way. And it is in this way a possible change maker - beginning with confrontation and ending with some level of understanding and resolution between community members. It's difficult to teach adults to change their attitudes about such fundamental things. That's why CLTS is necessary in some cases. Surely when it comes to educating young students, neither shame nor swearwords are necessary.

Thanks so much for the attached paper!

It seems as if there is a lot of overlap between the behavioural change approach used in that study and the work of behavioural economists in developing nudges. Undoubtedly emotional drivers are huge determinants of actual behaviours (as opposed to stated behaviours) - there are numerous psychology studies that have established this, and behavioural economics quite deliberately draws upon emotions as well.

I think that the issue that is being dealt with in "The Dirty Fight" is the use of negative emotions such as disgust and shame, as opposed to positive emotions such as happiness, security, or comfort. Emotions are incredibly powerful and they have to be deployed with extreme care, which I don't believe is the case in the TSC whistle-blowing. Shame, in particular, is a highly loaded emotion that is associated with identity and inherent unworthiness/dirtiness, as opposed to guilt, which is something attached to an event or a behaviour. WASH is often a setting for gender-based violence (sexual harassment in water or toilet queues, rape in toilet stalls or practices of open defecation), and sexual assault is fairly common (underreporting is rampant, and there are widespread cultures of silence that surround sexual violations). Trauma is at particularly high rates among disadvantaged groups precisely because they are in positions of less power, and these groups are for the most part the kinds of target groups that WASH practitioners work with. As a result, WASH is already a highly traumatizing and triggering experience for these populations, and deeply associated with shame, self-hate, feelings of powerlessness, and loss of hope.

To continually use shame as a way to motivate people to practice WASH behaviours is to retraumatize vulnerable populations, increasing a number of mental health symptoms ranging from dissociation, flashbacks, insomnia, mood disorders, eating disorders, and self-harming practices (cutting, burning, suicide). As of yet, there are no mental health studies following up on WASH interventions. Moreover, while people may comply with WASH behaviours out of sheer fear, these are not sustainable practices and they will lapse once pressure eases off, as there is an inherent emotional association of WASH with being unsafe, in pain, and in danger. The behavioural urges associated with such emotions are to avoid and hide, which discourages use of WASH facilities altogether. We are setting ourselves up for failure if we continue to use practices based upon short-term effects, and which lack any comprehensive understanding of secondary consequences in addition to long-term effects.

And most importantly, we are doing already exploited communities a great disservice by wilfully harming the most vulnerable groups.

Arno, you make some very interesting points here - but I think the idea of using 'swearwords' is to attempt at some level to break the taboo rather than reinforce it.

The psychology of words for faeces (and for swearwords in general) is really interesting. I don't know how it is in other languages, but in English words that derive from Latin or Greek are considered acceptable (even scientific) whereas words with the same meaning with an Anglo-Saxon root are harsh and disgusting. There is nothing 'wrong' with the terms urine and faeces, but they are not words that are commonly used by normal people, and I think the effort to break that taboo that surrounds the words which are commonly used (usually as swearwords as you say) is linked to the taboo of silence on sanitation. To make these words ordinary is to make them an ordinary (rather than a disgusting) part of the vocabulary, because we do need more people to talk more often about safe faecal management.

To solve this dilemma like all other human taboos is to stare the devil in the face and break down the attitudinal and communication barriers. It also requires coming to terms with this on a personal and private basis in order to make this change. It starts at home and at work. CLTS does move into this arena and it does have positive impacts. Community Health Clubs can do this is as well.

Can you explain more about what you mean here? Are you referring to the taboos of language or of shame? It sounds like you are saying that using certain words reinforce the shame aspect but I don't really understand what you mean. How do you think CLTS could 'move into this arena' given it seems to be largely based on shame?

To me, it seems like shaming people is a pretty defeatist thing to do. If one is hoping that they will do something about sanitation when they do not have the basic knowledge needed, then this seems like punishing victims for not knowing something.

Whistle-blowing by students to stop open defecators is like promoting gang-mobbing as a sort of rule of law. There are underlying reasons for why open defecation is practiced. One billion open defecators cannot be wrong.

The psychology of shaming people for defecating in the open or even discussing defecation in public is a deep-rooted one relating to the commonly shared taboo surrounding human excreta. I would even accuse WASH experts and senior officials for indirectly contributing to this behavior when they use swear words to describe human excreta. This is the last chapter in human development and most people have not progressed beyond childhood when it comes to discussing excreta.

What are the underlying messages from senior managers blasting out the word SH*T on stage in front of an audience when they refer to the billions without toilets? Most humans are incapable of taking the proper terms for excreta on board, because they don't really feel comfortable with the whole thing in the first place. What's wrong with the terms urine and faeces? Why aren't there equivalent swear words for food or drink?

To solve this dilemma like all other human taboos is to stare the devil in the face and break down the attitudinal and communication barriers. It also requires coming to terms with this on a personal and private basis in order to make this change. It starts at home and at work. CLTS does move into this arena and it does have positive impacts. Community Health Clubs can do this is as well.

Once accomplished, a more sensible dialogue on open defecation can then take place and one will quickly find out what is really going on. Questions relating to community development, livelihoods, access to services, sharing of wealth, knowledge, democracy, etc. may all pop up as underlying causes. Sounds all familiar? Are we actually that close to solving this without knowing it?

Regards

Dear Stephanie Tam,

It was nice to see your interesting post. I also view that sanitation problems should be dealt with dignity and respect and, people should not be ridiculed, insulted or degraded.

Please don’t forget to send me your paper, when done. The brief outline, you have given, sounds interesting to me.

Few months back, I got a paper on “Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial” (attached). I requested Dr Adam Biran, London School of Hygiene & Tropical Medicine, London, one of the authors, for some elaboration on “emotional drivers.”

Dr Adam sent me a very informative reply, which I would like to share here:

We suggest that human brains have three distinct but connected systems by which they process information and respond with behaviours.

1) Reflexive and habitual responses
2) Active, rational thinking
3) Responses to emotions.

Traditionally, public health has focussed on rational thought -explaining to people the steps they can take to protect themselves and their family.

We suggest that responses to emotions may be more effective.

For example - we believe that humans have a strong, emotional, adverse reaction to the sight and smell of faeces. We call this 'disgust'. Being disgustsed motivates us to behave in a particular way - to avoid or remove a potential source of contamination.

We believe that there is a finite set of emotional drivers - or human motivations. These are universal across cultures though there will be cultural differences in the ways in which these are triggered or symbolised.

In our intervention we deliberately avoided rational messages about health beliefs and tried instead to give the behaviour of handwashing a positive emotional value - nurturing a child and receiving the child's love in return, avoiding disgusting stimuli by removing potential contamination from hands and conforming with socially acceptable standards of behaviour (trying to create a social norm for handwahsing with soap).

Regards,

F H Mughal

Not a big fan of such tactics either, but I think one needs to acknowledge the other side too, i.e. open defecation is not simply an individual problem but rather one that effects entire communities, so exerting social pressure on the offenders is to some extend justified.

The main problem seems to be that it is "all sticks and no carrots", which given the low economic capabilities of many offenders isn't very likely to work in the medium to long term.

I'm glad there's been more recognition of the problems with using a shaming strategy to enforce sanitation behaviours. This one seems to follow in a line of newspaper articles discussing rights violations, debasement of open-defecation practitioners especially those from more vulnerable sectors (women, children, extreme poor), and even violence (one article talks about community-sanctioned stoning) spurred by CLTS. The overall reaction they seem to be trying to elicit from the public is a sense of injustice and censure towards demeaning enforcement practices.

While I'm totally of the opinion that shaming is a morally reprehensible tactic, what I think a lot of these articles and those who express similar opinions end up facing is a group of cynics who argue that "tough love" is needed. Because shaming has yet to be enshrined in humanitarian guidelines as human rights violations, it's thought of as acceptable, and those who don't agree with it are regarded as simply too "soft-hearted" to work in ID.

I'm currently working on a paper to discuss the deleterious effects of shaming tactics, and there are many, many effects that do not fall within the purview of WASH and are therefore not acknowledged let alone monitored and evaluated. Coming from a trauma perspective and using a neurobiological model to discuss how shame affects the way the brain functions, I'm working on discussing how shaming or bullying is in fact harmful to health and creates a host of new problems. Biological anthropologists have long pointed out the relationship between sustained emotional stimulation (heightened cortisol levels among racially discriminated groups, for example) and increased morbidity and mortality rates. If we're lowering death rates from diarrheal diseases, we're simultaneously increasing death rates from a spiked cardiovascular system. If we want people to stop practicing open defecation, we need to find non-harming, sustainable methods (I personally am a proponent of using subconscious nudging).

This seems to be reported fairly widely in the Indian press. The Times of India gives a bit more information on the whistle campaign: timesofindia.indiatimes.com/city/bangalo...cleshow/44634779.cms

When the rest of the country is campaigning to put an end to defecating in the open through speeches, Gadag zilla panchayat has come up with a whistle-blowing campaign.

It has formed teams of men and women who will blow whistles to discourage people who create nuisance in public places. ZP CEO Sanjay B Shettennavar, who inaugurated the campaign 10 days ago, said it's an easy way to reach and convince residents of 328 villages to create awareness about toilets.

"Apart from street plays, gram sabhas, awareness processions and human chains, we found that some people haven't constructed toilets yet. To create awareness in such families, we decided to take the campaign to public spaces where they defecate," he said.

I can't say that I like this idea. In fact, I'm starting to think that the whole idea of using shame tactics is pretty low.

The attached piece was sent yesterday by the World Hygiene Programme, under newsletter: The Daily WASH is out! Edition of 02 November 2014.

www.telegraphindia.com/1141029/jsp/opini...484.jsp#.VFZNHmca8xI

Title: The Dirty Fight
The Telegraph, Calcutta, India
Author: Amitangshu Acharya

Talking of shame in sanitation, the writeup says:

In recent years, NGOs and state governments have attempted to send those who defecate in the open in urban and rural India scurrying into toilets by shaming them in public. It started with equipping children with whistles, which they would blow at any villager caught relieving themselves in the open. Later it took on newer forms — in Satara in Maharashtra, the ‘Good Morning’ campaign witnessed volunteers hiding in areas where people defecated in the open and detaining whoever was caught. School bands were made to play in front of ‘toiletless’ households to shame them into building one. In the neighbouring state of Madhya Pradesh, the government put up hoardings which show villagers and dogs defecating in the open side by side, and exhorting villagers to not behave like their four-legged counterparts. Under the ‘Maryada’ campaign in MP, each village is to set up a sanitation monitoring committee which takes photographs and videos of villagers defecating in the open and threatens a public screening unless they agree to build or use a toilet.

While sanitation campaigns in rural India seem to be doing well in promoting dignity by taking it away from people, urban India is not far behind. Masked vigilantes in Mumbai, manning a bright yellow water tanker, are sneaking up on unsuspecting people urinating in public and turning the water hose on them. As the victims make desperate efforts to escape, a crowd gathers around.


I have highlighted the above contents, in red, in the attachment. Can anyone comment on the above contents?

F H Mughal